Utilization of Artificial Intelligence-based Intracranial Hemorrhage Detection on Emergent Noncontrast CT Images in Clinical Workflow

Authors implemented an artificial intelligence (AI)-based detection tool for intracranial hemorrhage (ICH) on noncontrast CT images into an emergent workflow, evaluated its diagnostic performance, and assessed clinical workflow metrics compared with pre-AI implementation. The finalized radiology report constituted the ground truth for the analysis, and CT examinations (n = 4450) before and after implementation were retrieved using various keywords for ICH. Diagnostic performance was assessed, and mean values with their respective 95% CIs were reported to compare workflow metrics (report turnaround time, communication time of a finding, consultation time of another specialty, and turnaround time in the emergency department). Although practicable diagnostic performance was observed for overall ICH detection with 93.0% diagnostic accuracy, 87.2% sensitivity, and 97.8% negative predictive value, the tool yielded lower detection rates for specific subtypes of ICH (eg, 69.2% [74 of 107] for subdural hemorrhage and 77.4% [24 of 31] for acute subarachnoid hemorrhage). Common false-positive findings included postoperative and postischemic defects (23.6%, 37 of 157), artifacts (19.7%, 31 of 157), and tumors (15.3%, 24 of 157). Although workflow metrics such as communicating a critical finding (70 minutes [95% CI: 54, 85] vs 63 minutes [95% CI: 55, 71]) were on average reduced after implementation, future efforts are necessary to streamline the workflow all along the workflow chain. It is crucial to define a clear framework and recognize limitations as AI tools are only as reliable as the environment in which they are deployed. (C)RSNA, 2022

Automated summary

Authors implemented an AI-based detection tool for intracranial hemorrhage and evaluated its diagnostic performance and impact on clinical workflow. While the overall diagnostic accuracy was 93.0%, lower detection rates were observed for specific types of ICH. Workflow metrics showed a reduction in average time for communicating critical findings post-implementation, but further improvements are needed to streamline the entire workflow chain.